Pioneering a Dental Traumatology Renaissance in Asia

A team of global experts and Malaysian academics are joining forces to raise awareness and standards around managing dental trauma cases, catalyzing a regional movement by uniting research, education, industry and community engagement.

By Danny Chan

Each year, countless individuals around the world suffer dental and oral injuries from accidents, sports, and other traumatic events. Despite the prevalence of these incidents, there remains a significant gap in knowledge and awareness among dental professionals and the general public when it comes to properly managing dental trauma cases.

A passionate group of international experts in dental traumatology has joined forces with their Malaysian colleagues to bring this crucial area into sharper focus, starting with an ambitious initiative and conference hosted by the Universiti Malaya (UM).

“Dental traumatology is very important in Asia, particularly because there has not been strong exposure to the community, both the general community and the dental community,” explains Professor Hien Ngo, who has spearheaded the collaboration. “The awareness of dental traumatology is deficient. However, there is a great need.”

Prof. Ngo points to the high rates of trauma from sources like motorcycle accidents across Asia, resulting in fractures of the jaw, teeth, and surrounding areas. Yet the approach to managing such cases often falls short of current best practices. “So, it’s important that we bring this awareness into both the dental and the general community,” he states.

A Pioneering Conference Sparks Change

That drive to fill the traumatic knowledge gap formed the impetus behind the Universiti Malaya’s inaugural International Dental Traumatology Conference held from 2nd – 3rd March 2024. The conference featured Prof. Ngo alongside other globally renowned figures like Prof. Lars Andersson, past president of the International Association of Dental Traumatology (IADT), and Prof. Paul Abbott, a decades-long educator on dental trauma management.

“Dental trauma is actually very common. It’s been estimated, around about one billion people have had trauma to the mouth and the teeth at some stage in their life,” says Prof. Abbott. “So it’s a common problem. And you even can call it a public health problem.”

Yet as Prof. Abbott notes, numerous studies across countries have revealed suboptimal knowledge among dentists for properly treating dental trauma cases. “People like myself, Lars, Hien and others involved in traumatology, we have sort of taken it on that we want to try and educate dentists to manage trauma in a better way.”

The conference proved to be an overwhelming success, exceeding all expectations for attendance. As A/Prof. Hany Mohamed Aly Ahmed, UM’s Associate Professor of Endodontics recounts, “Initially, we were expecting a turnout of about 150 to 200. We reached 200 participants within two weeks and had to change to a larger venue. In the end, unfortunately, we had to turn away interested parties because we have reached maximum capacity.”

Building Toward a Comprehensive Movement

The tremendous response highlighted the thirst among Malaysian dental professionals to improve their trauma knowledge and skills. But the conference aimed not just to educate, but to catalyze further initiatives.

Reflecting that vision, the Universiti Malaya team has already begun developing follow-up programs and research projects. According to A/Prof. Dr. Noor Azlin Yahya, they are “looking at the effects of discoloration” as one research focus. Workshops on splinting methods and efforts to raise community awareness through pilot projects in local schools are also underway.

“We are aiming actually to also involve specialists from the medical school so that they also give a more generalized view of the types of traumatic injuries…regarding injuries in the head region as well,” adds Prof. Hany. The goal is a comprehensive, multidisciplinary approach to dental traumatology education.

“The message we want to propagate is it’s just like when you have a stroke, what happens to you in the first half an hour determines your long-term clinical outcome”

– Prof. Hien Ngo

Establishing a National Society to Drive Progress

The Universiti Malaya has taken the first bold step, leveraging global expertise to spark a new movement from Malaysia outward. If this dedicated team has their way, the ripples will extend across Asia, equipping dentists, communities, and the public at large to address dental trauma with a newly heightened sense of urgency, knowledge, and unified purpose.

While their ambitions are far-reaching, the academics are taking a methodical approach to expanding their efforts across the region. As Prof. Hany explains, “In order to also start promoting or discussing with others, you have to be on very solid ground first. I mean, we have to discuss together first, and then we have a  well-justified document or agenda. And after this, we’ll start to discuss with others and listen to their input.”

A key next step is establishing a national dental trauma society in Malaysia to formalize and provide structure for the work. “We hope to come up with the society by this year,” says Assoc. Prof. Dr. Noor Azlin. “We hope to set it up while the momentum is still there from the first conference and activities.”

The society will serve as a hub for coordinating research, education programs, clinical guidelines and other initiatives oriented around dental traumatology. Its formation underscores the cross-disciplinary nature of the field.

By fostering collaboration between general dentists, specialists like endodontists and oral surgeons, and other stakeholders like school communities, a national society can help disseminate traumatology best practices widely. The public awareness component is particularly crucial.

Emphasizing Community Education and Outreach

“The message we want to propagate is it’s just like when you have a stroke, what happens to you in the first half an hour determines your long-term clinical outcome,” says Prof. Ngo. “The same thing, if a tooth is traumatized, what do you do in the first half an hour is very important to the long-term result for the child or teenager.”

Educating teachers, coaches, parents and the general public on basic protocols for responding to dental avulsions or injuries could dramatically improve long-term outcomes. Tools like the Dental Trauma Guide online providing case-specific trauma advice can also aid both professionals and laypeople in triaging these emergencies properly (www.dentaltraumaguide.org).

Looking further ahead, the academics envision Malaysia potentially hosting an Asian version of the IADT’s long-running World Dental Trauma Congress as another major milestone. More than 20 such world congresses have been arranged since 1982 worldwide. Such an event could unite the region’s dental communities around the shared traumatology cause.

“We are keen to go forward with that idea,” Prof. Ngo states. “We already have projects going on in some other countries as well.”

From that seminal conference in March 2024, an ambitious multi-year agenda is taking shape to illuminate one of dentistry’s most crucial yet underserved segments. It is an inclusive vision where international experts and local champions alike have a role to play in scripting dental traumatology’s next impactful chapter across Asia.

“This is an amazing team, it’s a dream team,” says UM’s Dental Faculty Dean, Prof. Zamri Radzi. “And I think we made good progress in a very short span of time and it’s amazing. And we’re planning more wonderful things in the pipeline.”

The Merging of Expertise and Vision

The momentum driving this dental traumatology movement stems from the convergence of decades of expertise with a clear-eyed vision for the future. Seasoned giants of the field like Prof. Lars Andersson have worked tirelessly to develop and spread trauma management knowledge globally.

“I can give you a historical perspective back, actually to the 80s when we realized that it was not possible to develop dental traumatology through one specialty, because all specialties had to be involved,” Prof. Andersson recounts. “That’s why we in the 80s, decided to work together, together in an inter-disciplinary way, to arrange meetings locally, and later on in regional meetings.”

Those humble grassroots beginnings blossomed into the IADT World Dental Trauma Congresses, which have now spanned 22 editions across the globe. “All these together have been very successful. And we have started up interest in different parts of the world,” says Prof. Andersson. “And it would be really great to have such an association leading the development in Southeast Asia, where we go together with all the specialties. That’s really where we will see development.”

The Malaysian dental industry is also being engaged as a partner in this ecosystem-building effort. During the conference, A/Prof. Hany initiated conversations with companies about the pivotal role dental materials, equipment and other products play in trauma treatment modalities like root canals, restorations, bleaching and splinting.

Tying together all these components – professional societies, academia, clinical disciplines, industry and public engagement – under a unified traumatology umbrella is an ambitious but vital undertaking. It’s about creating a holistic, sustainable infrastructure for enduring progress.

“We have numerous examples in South America, in India, in Europe, where people start taking a course in dental traumatology. This way of thinking is new to many people. Working in an interdisciplinary way is not very common in dentistry, we usually develop the collective profession through our own specialties. But here is a field where you have to go together.”

– Prof. Lars Andersson

Leveraging Lessons from Abroad

While the specific initiatives will be tailored for the Malaysian and broader Asian context, the academics can draw upon a wealth of learnings and best practices from other parts of the world that have previously traveled this traumatology awareness-building path.

As Prof. Lars Andersson has witnessed firsthand: “We have numerous examples in South America, in India, in Europe, where people start taking a course in dental traumatology. This way of thinking is new to many people. Working in an interdisciplinary way is not very common in dentistry, we usually develop the collective profession through our own specialties. But here is a field where you have to go together.”

“What has happened in all these continents is that those people stimulated by such a conference will take the lead, and they will give courses and develop in their own regions and markets,” he continues. “So that’s really the way to go. And the initiative by Universiti Malaya is fantastic.”

Making an Impact Through Research

In addition to developing educational initiatives and a national trauma society infrastructure, the Universiti Malaya team is also focusing intensively on building a robust research agenda around dental traumatology. Several grant proposals and pilot studies are already in the works. One major initiative aims to raise community awareness and education, especially within the school system.

“We will first conduct a survey, focused on the school community including parents,” outlines Assoc. Prof. Dr. Noor Azlin. “We want to know in their opinion, how important is it, how are you going to manage it? After that, the second stage is the intervention…to educate the school community.”

By assessing knowledge levels before and after educational programs, the researchers can quantify their real-world impact and continually refine their methods. The goal is a comprehensive, standardized curriculum to equip teachers, coaches, parents and students alike with vital trauma response protocols.

On the clinical research front, one unique focus is developing more customized splinting techniques based on the specific dental trauma incident. As Prof. Hien Ngo explains, “In the old days, we splinted everything the same way with the same type of splint. Now we are individualizing the splint, thinking about the type of tissue that has been involved and using different splinting times and different flexibility levels.”

The Malaysian team is setting up specialized testing platforms to evaluate and validate these next-generation splinting approaches. “And this new initiative that you have taken at the Universiti Malaya, with research on splints can really lift up the level of how the world approaches splinting in the future,” states Prof. Ngo. “So, I think UM is once again a leader.”

Another area of emphasis is investigating the etiology and clinical management of tooth discoloration following dental trauma, a poorly understood yet prevalent issue. Prof. Hany has begun compiling an expansive collection of clinical cases exhibiting varied discoloration patterns for teeth with previous traumatic injuries.

“We’ll have to differentiate between how each color can reflect which underlying pathology, for example,” he describes. “We aim to summarize the etiology of coronal discoloration following trauma, and then what are the diagnoses and how we can manage these cases in a step-wise manner.”

By diving deep into key clinical challenges like splinting and discoloration, the Malaysian researchers hope to not only advance regional standards of care, but also make substantive contributions to global traumatology literature and guidelines.

We also have to standardize registration of traumatic dental injuries worldwide, and recently WHO has adopted a standardized classicication of traumatic dental injuries in their international classification of diseases. In the future when we register in a standardized way, we can gain experience from the outcome of different injuries by comparing our treatment in larger materials. An interdisciplinary association in Asia can promote such a development for the region.

The flourishes of an academic and professional renaissance are taking root. Now it’s up to the Malaysian team, fortified by their global partnerships, to nurture that seedling into a trauma-informed reality that can span the entire Asian continent.